P1577: RISK FACTORS FOR MORTALITY IN CRITICALLY ILL PATIENTS WITH HEMATOLOGICAL MALIGNANCIES IN A POLYVALENT INTENSIVE CARE UNIT: A RETROSPECTIVE STUDY
Authors: A. R. Dias, J. Gonçalves, F. Seganfredo, J. Gramaça, M. Rebelo, E. Carmo
Journal: HemaSphere (2022)

Background: Advances in critical care medicine have increased survival and quality of life in patients admitted to Intensive Care Unit (ICU). However, critically ill hemato-oncological (HO) patients still have a high risk of mortality, and stigma of poor prognosis may affect triage to ICU admission and clinical decisions. The available scoring systems are not specific for that population and the risk factors for adverse outcomes in HO patients remain poorly defined. Aims: The aim of our study is to analyze the risk factors for ICU mortality of HO patients. Methods: This retrospective, single-center study included 124 critically ill patients with HO diseases admitted in a polyvalent ICU between January 1st 2008 and December 31st 2021. Data regarding demographics, HO disease and therapy, disease severity scores, clinical and laboratorial parameters at admission, and organ support therapies instituted during ICU stay were collected from the ICU database. We compared data collected between survivors (n= 93) and non-survivors (n = 49). Univariate and multivariate logistic regression models were used to evaluate the potential risk factors for ICU mortality. Statistical tests were two-sided; p-values <0.05 were considered significant. Results: Median age was 65,5 [27-92] years and 60,5% (75) of patients were male. The majority of patients were admitted from other hospitals (39,5%), followed by medical hospital wards (29,8%). Most patients had non-Hodgkin lymphoma (37,9%), Acute Myeloid Leukemia (18,5%) and Hodgkin lymphoma (12.1%). 63,7% of patients were under treatment, 40,3% of which were under intermediate chemotherapy (Cht), and 23,4% under intensive Cht. The average time of hospital stay pre-ICU was 11,4 days (d) [CI 95% 8,9-13,8], and in the ICU was 8,9 [7,1-10,8]. The main reason for admission in the ICU was septic shock (47,6%), followed by respiratory failure (23,4%). Invasive mechanical ventilation (IMV) in the ICU was used for 62,1% of the patients, vasopressors for 66,9%, and renal replacement therapy (RRT) was used for 36,3%. ICU mortality rate was 39,5%. On univariate analysis, we identified as risk factors in the ICU for death the following factors: neutropenia (HR 1,73, CI 95% 0,98-3,1, p=0.06), sepsis or septic shock at ICU admission (HR 2,15, CI 95% 1,18-3,9, p=0.012), length of pre-ICU hospitalization >13 d (HR 1,43, CI 95% 0,81-2,55, p=0,22), Acute Physiology And Chronic Health Evaluation (APACHE) > 26 (HR 5,68, CI 95% 2,54-12,72, p<0,001), Simplified Acute Physiology Score II (SAPSII) score > 58 (HR 4,01, CI 95% 2,04-7,89, p<0,001), need of IMV (HR 3,60, CI 95% 1,41-9,81, p=0,007), vasopressors (HR 18,39, CI 95% 2,56-133,98, p=0,004) and RRT (HR 2,54, CI 95% 1,42-4,55, p=0,002). Factors including gender, ECOG, higher number of comorbidities, type of HO disease, need of ChT in the ICU or pre-admission ChT and fever at admission showed no significant impact (HR 10,45, CI 95% 1,40-78,00, p=0,022). Summary/Conclusion: In this study, characteristics of the underlying hematological malignancy didn’t have influence in the mortality, while the severity of infection, namely septic shock, and the need of organ supportive therapies correlated with mortality. Our findings reinforce that triage decisions solely based on the age or type of HO disease are not justified, but instead should be based on a multidisciplinary approach with intensivists and experienced hemato-oncologists.